Initial treatment recommendations for cracked teeth in Northwest PRECEDENT

Methods: Practices were asked to assess for the presence of cracks in a randomly selected subject starting with a randomly selected posterior tooth. Teeth were assessed via visual examination with magnification, tactile perception and transillumination. To be included, a crack had to block transilluminated light. Various patient-, tooth-, and crack-level criteria were assessed, along with treatment recommendations. The goal is for each practice to enroll 12 asymptomatic and 8 symptomatic cracked teeth and follow them for a minimum of 1 year. To aid in subject enrollment, practices could enroll any subject with a symptomatic cracked tooth that met inclusion criteria.

Results: 36 practices in NW PRECEDENT evaluated 570 randomly selected subjects for symptomatic and asymptomatic cracked posterior teeth. 400(70%) of randomly selected subjects presented with a cracked posterior tooth, 361(63%) asymptomatic and 39(7%) symptomatic. An additional 122 non-randomly selected subjects presented with a symptomatic cracked tooth for a total of 161 symptomatic cracked teeth. 143(89%) of symptomatic cracked teeth were recommended for the following treatments: restorative: 132(92%); endodontics: 5(3%); Extraction: 2(1%); Other: 10(7%). 66(18%) of asymptomatic cracked teeth were recommended for the following treatments: restorative: 63(95%); extraction: 1(2%); other: 5(8%). Symptomatic teeth were recommended for treatment for the following: pain: 122(85%); integrity: 103(72%); defective restoration: 24(17%); caries: 21(15%); structure: 20(14%); other: 12(9%). Asymptomatic teeth were recommended for treatment for the following: pain: 6(9%); integrity: 50(76%); defective restoration: 16(24%); caries: 19(29%); structure: 10(15%); other: 7(11%).

Conclusions: Findings show a high prevalence of cracked teeth, most of which were asymptomatic. Most treatment recommendations for both symptomatic and asymptomatic cracked teeth were for restorative treatment. Supported by NIDCR grants DE016750 and DE016752.